Two studies find that posting skilled staff is more effective than national missions in checking deaths during childbirth.
As women continue to die while giving birth, a couple of latest studies have underlined the need to track pregnancies and posting skilled attendants in rural areas through public-private partnerships.
Recently, Women and Child Development Minister Krishna Tirath was asked what her ministry intended to do to bring down the number of such deaths. She said the matter was dealt with by the health ministry.
The ministry is preoccupied with two things, one is the pet project of President Pratibha Patil, a national mission for empowerment of women, while the other is the minister’s pet project of creating ahimsa messengers to bring the changes the anganwadi workers failed to bring. Tirath could not explain how the project would stop mothers from dying.
The country today has a maternal mortality rate of about 300 per 100,000 but availability of skilled attendants is a mere 33.5 per cent. And according to the World Health Organisation, availability of skilled attendants can be more effective than national missions and messengers in ensuring the safety of both mother and child.
This is backed by a study published early this year by Public Health Research Institute, Mysore, and the San Francisco Department of Health. It says deploying human resources can be a good strategy to check maternal mortality and this can be achieved through public-private partnerships if the government does not have enough personnel, which is the case with India. It says that what is missing in rural India is skilled attendance. It says India has enough human resources but these are concentrated in the private sector. It suggests partnerships with the private sector and finds Gujarat and Tamil Nadu as good case studies.
Human Rights Watch, an international NGO, said in a recent report that even in a state like Uttar Pradesh, where 2,300 women die during childbirth everyday, there are just 580 community health centres. Only a third of these have gynaecologists. The maternal mortality rate in Uttar Pradesh is 440 per 100,000 births. India’s target for 2012 is less than 100 deaths per 100,000 births. The NGO says women dying in Uttar Pradesh are mostly victims of poor referral services as hospitals don’t direct patients to places that are equipped to deal with their cases. It also finds that not every death during childbirth is recorded. So, while the study found women dying during childbirth in Chitrakoot district, official data put the number of deaths at nil, said author Aruna Kashyap.
The outcome of every pregnancy must be recorded to ensure that every woman is safe, says Kashyap.
Here comes the role of Krishna Tirath and her ministry. Anganwadi workers are supposed to record deaths of pregnant women. Again, these workers are supposed to converge with health workers, or ASHAs, once a month and hold health and nutrition days in villages. This is for exchange of information. But obviously they are not keeping the ministry informed of their health activities.
Between the two ministries, what is evident is the absence of a proactive effort to investigate the deaths. Also absent is an urgency to make available enough specialists in rural areas.
